Systems and methods for secure cloud-based medical image upload and processing

ABSTRACT

Presented herein are systems and methods that facilitate user review and uploading of files comprising medical images and associated metadata from a local computing device to a network-based image analysis and/or decision support platform. The systems and methods described herein allow image upload to be performed in a secure fashion that prevents the network-based platform from accessing sensitive data as it is prepared for upload. Prior to file upload, sensitive data elements are flagged and their values removed and/or masked. Notably, the approaches described herein provide intuitive graphical user interface (GUI) tools that allow a user, such as a medical practitioner or researcher, to review not only the images and metadata in the files that they plan to upload, but also to review and control the process by which sensitive data elements are removed and/masked, thereby confirming that all files are free of sensitive information prior to upload.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to and benefit of U.S. ProvisionalApplication No. 62/907,168, filed Sep. 27, 2019, the content of which ishereby incorporated by reference in its entirety.

FIELD OF THE INVENTION

This invention relates generally to methods and systems, for analysisand/or presentation of medical image data. More particularly, in certainembodiments, the invention relates to methods and systems forfacilitating transfer of medical image data to cloud-based platforms.

BACKGROUND OF THE INVENTION

Targeted image analysis involves the use of radiolabeled small moleculesthat bind to specific receptors, enzymes and proteins in the body thatare altered during the evolution of disease. After administration to apatient, these molecules circulate in the blood until they find theirintended target. The bound radiopharmaceutical remains at the site ofdisease, while the rest of the agent clears from the body. Theradioactive portion of the molecule serves as a beacon so that an imagemay be obtained depicting the disease location and concentration usingcommonly available nuclear medicine cameras, known as single-photonemission computerized tomography (SPECT) or positron emission tomography(PET) cameras, found in most hospitals throughout the world. Physicianscan then use this information to determine the presence and the extentof disease in a patient. The physician can use this information toprovide a recommended course of treatment to the patient and to trackthe progression of disease.

There are a variety of software-based analytical techniques availablefor analysis and enhancement of PET and SPECT images that can be used bya radiologist or physician. There are also a number ofradiopharmaceuticals available for imaging particular kinds of cancer.Imaging agents used in the art include, among others include, withoutlimitation ¹⁸F-NaF, ¹¹C-Choline, 2-deoxy-2 [18F] fluoro-d-glucose (FDG),and the like. For example, the small molecule diagnostic 1404 targetsthe extracellular domain of prostate specific membrane antigen (PSMA), aprotein amplified on the surface of >95% of prostate cancer cells and avalidated target for the detection of primary and metastatic prostatecancer. 1404 is labeled with technetium-99 m, a gamma-emitter isotopethat is widely available, relatively inexpensive, facilitates efficientpreparation, and has spectrum characteristics attractive for nuclearmedicine imaging applications.

Another example radiopharmaceutical is PyL™ (also known as [¹⁸F]DCFPyL,and 18F-PyL), which is a clinical-stage, fluorinated PSMA-targeted PETimaging agent for prostate cancer. A proof-of-concept study published inthe April 2016 issue of the Journal of Molecular Imaging and Biologydemonstrated that PET imaging with PyL™ showed high levels of PyL™uptake in sites of putative metastatic disease and primary tumors,suggesting the potential for high sensitivity and specificity indetecting prostate cancer.

An oncologist may use images from a targeted PET or SPECT study of apatient as input in her assessment of whether the patient has aparticular disease, e.g., prostate cancer, what stage of the disease isevident, what the recommended course of treatment (if any) would be,whether surgical intervention is indicated, and likely prognosis. Theoncologist may use a radiologist report in this assessment. Aradiologist report is a technical evaluation of the PET or SPECT imagesprepared by a radiologist for a physician who requested the imagingstudy and includes, for example, the type of study performed, theclinical history, a comparison between images, the technique used toperform the study, the radiologist's observations and findings, as wellas overall impressions and recommendations the radiologist may havebased on the imaging study results. A signed radiologist report is sentto the physician ordering the study for the physician's review, followedby a discussion between the physician and patient about the results andrecommendations for treatment.

Thus, the process involves having a radiologist perform an imaging studyon the patient, analyzing the images obtained, creating a radiologistreport, forwarding the report to the requesting physician, having thephysician formulate an assessment and treatment recommendation, andhaving the physician communicate the results, recommendations, and risksto the patient. The process may also involve repeating the imaging studydue to inconclusive results, or ordering further tests based on initialresults.

If an imaging study shows that the patient has a particular disease orcondition (e.g., cancer), the physician discusses various treatmentoptions, including surgery, as well as risks of doing nothing oradopting a watchful waiting or active surveillance approach, rather thanhaving surgery.

There are limitations associated with this process, both from theperspective of the physician and from the perspective of the patient.While the radiologist's report is certainly helpful, the physician mustultimately rely on her experience in formulating an assessment andrecommendation for her patient. Furthermore, the patient must place agreat deal of trust in his physician. The physician may show the patienthis PET/SPECT images and may tell the patient a numerical riskassociated with various treatment options or likelihood of a particularprognosis, but the patient may very well struggle to make sense of thisinformation. Moreover, the patient's family will likely have questions,particularly if cancer is diagnosed but the patient opts not to havesurgery. The patient and/or his family members may search online forsupplemental information and may become misinformed about risks of thediagnosed condition. A difficult ordeal may become more traumatic.

Thus, there remains a need for systems and methods for improvedautomated analysis of medical imaging studies and communication of thoseresults, diagnoses, prognoses, treatment recommendations, and associatedrisks to a patient.

SUMMARY OF THE INVENTION

Presented herein are systems and methods that facilitate user review anduploading of files comprising medical images and associated metadatafrom a local computing device to a network-based image analysis and/ordecision support platform. The systems and methods described hereinallow image upload to be performed in a secure fashion that prevents thenetwork-based platform from accessing sensitive data as it is preparedfor upload. Prior to file upload, sensitive data elements are flaggedand their values removed and/or masked. Notably, the approachesdescribed herein provide intuitive graphical user interface (GUI) toolsthat allow a user, such as a medical practitioner or researcher, toreview not only the images and metadata in the files that they plan toupload, but also to review and control the process by which sensitivedata elements are removed and/masked, thereby confirming that all filesare free of sensitive information prior to upload.

In the context of medical images, where patient privacy is paramount,this process allows a user, such as a medical practitioner, to ensurethat uploaded files are free of any data that could be used to ascertainidentity of a particular patient. By allowing a user to securely andconfidently interact with cloud-based platforms that can dramaticallyfacilitate data analysis, collaboration, and communication of results,the interactive tools for data upload described herein offer keyfunctionality facilitating medical image analysis.

In one aspect, the invention is directed to a method for secure uploadof one or more (e.g., a plurality of) medical images and associatedmetadata from a local computing device to a network-based (e.g., acloud-based) analysis and/or decision support platform, the methodcomprising: (a) causing, by a processor of the local computing device,display of a graphical user interface (GUI) for user review andmanagement of medical image upload; (b) receiving, by the processor ofthe local computing device (e.g., via the GUI), a user selection of oneor more files for upload, wherein each of the one or more files forupload comprises one or more medical image(s) and associated metadatacomprising a plurality of data elements [e.g., that convey informationabout the associated medical image, such as information about aparticular patient (e.g., the imaged patient), a particular study thatthe image was collected as part of, imaging parameters (e.g., theimaging modality), and the like], and wherein each selected file (of theone or more files for upload) is stored on the local computing device(e.g., that is not part of the network-based (e.g., a cloud-based)analysis and/or decision support platform); (c) accessing, by theprocessor of the local computing device, for each selected file, theassociated metadata of the file and identifying, among the plurality ofdata elements of the associated metadata, one or more flagged dataelements for de-identification prior to upload; (d) creating, by theprocessor of the local computing device, for each selected file,de-identified metadata corresponding to the associated metadata of thefile with values of the flagged data elements removed and/or masked(e.g., replaced with a masking value that obscures the original valueand/or conveys more limited information); (e) receiving, by theprocessor of the local computing device (e.g., via the GUI), a userselection of a particular file for review of de-identification; (f)responsive to the user selection of the particular file, causing, by theprocessor of the local computing device, (e.g., via the GUI) display ofa graphical representation of metadata changes comprising a listing ofthe plurality of data elements of the associated metadata of theparticular file and a visual indication of the one or more flagged dataelements (e.g., identifying flagged data elements in particular colors,text formatting, etc. so as to visually distinguish from other dataelements, placing color coded icons/indicators in proximity to flaggeddata elements, etc.); (g) receiving, by the processor of the localcomputing device, a user confirmation to upload; and (h) (e.g.,responsive to the receipt of the user confirmation to upload) uploading,by the processor of the local computing device, each selected file withthe original associated metadata replaced with the correspondingde-identified metadata, to the network-based platform.

In certain embodiments, the method comprises: (i) causing, by theprocessor, (e.g., via the GUI; e.g., responsive to receipt of a userinput to display de-identified metadata) display of a graphicalrepresentation of the de-identified metadata that corresponds to theassociated metadata of the particular file.

In certain embodiments, the method comprises: (j) causing, by theprocessor, (e.g., via the GUI; e.g., responsive to receipt of a userinput to display original metadata) display of a graphicalrepresentation of original associated metadata of the particular file(e.g., without the visual indication of the one or more flagged dataelements).

In certain embodiments, at least a portion of the flagged data elementsare identified as elements to be masked by, for each element to bemasked, replacing an initial value of the element to be masked with aparticular masking value, and wherein the graphical representation ofmetadata changes further comprises, for each element to be masked, anindication of the initial value of the element and an indication of theparticular masking value for the element.

In certain embodiments, in the graphical representation of metadatachanges, the listing of the plurality of data elements of the associatedmetadata is displayed in a table [(e.g., each data element displayed ina row, with an indication of its value) (e.g., wherein each flagged dataelement is identified via a colored indicator (e.g., a red indicatordisplayed next to elements to be removed and/or masked)(e.g., wherein,for each particular data element identified as elements to be masked, anadditional row showing the masking value for that particular dataelement included below the row for that particular data element)].

In certain embodiments, at least a portion of the flagged data elementsare identified as elements to be masked (e.g., as opposed to removed)and wherein step (c) comprises, for each element to be masked, replacingan initial value of the element to be masked with a particular maskingvalue.

In certain embodiments, step (c) comprises accessing, by the processor,a stored de-identification protocol comprising a listing of dataelements to flag.

In certain embodiments, the method further comprises: receiving, by theprocessor, (e.g., via the GUI), a user selection of one or moreadditional data elements to flag for de-identification; and updating, bythe processor, the de-identified set of metadata associated with eachmedical image to remove and/or mask a value of each selected additionaldata element.

In certain embodiments, the one or more flagged data elements compriseone or more members selected from the group consisting of: a patientname, a patient identifier [e.g., a unique (e.g., numeric oralphanumeric) identifier assigned to the patient], a patient birth date.

In certain embodiments, the local computing device is in communication[e.g., connected to via data acquisition/instrument control hardwareand/or channels, such as USB, serial, Ethernet/local area network (LAN),general purpose interface bus (GPIB), etc.; e.g., in communication overa network (e.g., a local private network)] with an imaging system [e.g.,a computed tomography (CT) scanner; e.g., a magnetic resonance imaging(MRI) scanner; e.g., a positron emission tomography (PET) scanner; e.g.,a single photon emission computed tomography (SPECT) scanner; e.g., agamma camera scanner (e.g., a scintigraphy imaging scanner); e.g., acombined CT/PET, CT/SPECT, MRI/PET, MRI/SPECT scanner].

In certain embodiments, the local computing device on a local network(e.g., a private, limited access network, such as a network of ahospital or group of hospitals, a network of a research organization,and the like) that is not part of the network-based (e.g., acloud-based) analysis and/or decision support platform.

In certain embodiments, the method comprises: following step (b),performing, by the processor of the local computing device, apre-processing step to validate each of the one or more selected filesfor upload (e.g., to confirm that each selected file comprises a medicalimage of a particular type and/or format).

In certain embodiments: the pre-processing step comprises identifying,for each file, a corresponding study to which the file belongs, therebyidentifying one or more processed studies; and the method comprisescausing, by the processor of the local computing device, display of(e.g., via the GUI) a graphical representation of processed studiescomprising a listing of the one or more processed studies [e.g., whereinthe processed studies are displayed in tabular format with eachprocessed study shown in a different row].

In certain embodiments, the graphical representation of processedstudies comprises, for each processed study, a visual indication of anumber of different files (e.g., a rendered numerical value in a row) ofthe study along with a visual indication of one or more imagingmodalities used to obtain medical images of the files belonging to thestudy (e.g., rendered text and/or icons representing particular imagingmodalities).

In certain embodiments, the method comprises: receiving, by theprocessor of the local computing device, a user input to review imagesof a particular study; and causing, by the processor of the localcomputing device, display of (e.g., via the GUI) a first medical imageof a first file and corresponding to (e.g., obtained using) a particularimaging modality, along with a graphical control element that allows theuser to view additional images (i) of files belong to the particularstudy and (ii) also corresponding to the particular imaging modality(e.g., thereby allowing the user to conveniently scroll through imagesof the particular study and corresponding to the particular imagingmodality).

In another aspect, the invention is directed to a system for secureupload of one or more (e.g., a plurality of) medical images andassociated metadata from a local computing device to a network-based(e.g., a cloud-based) analysis and/or decision support platform, thesystem comprising: a processor of the local computing device (e.g., notpart of the network-based platform); and a memory having instructionsstored thereon, wherein the instructions, when executed by theprocessor, cause the processor to: (a) cause display of a graphical userinterface (GUI) for user review and management of medical image upload;(b) receive (e.g., via the GUI), a user selection of one or more filesfor upload, wherein each of the one or more files for upload comprisesone or more medical image(s) and associated metadata comprising aplurality of data elements [e.g., that convey information about theassociated medical image, such as information about a particular patient(e.g., the imaged patient), a particular study that the image wascollected as part of, imaging parameters (e.g., the imaging modality),and the like], and wherein each selected file (of the one or more filesfor upload) is stored on the local computing device (e.g., that is notpart of the network-based (e.g., a cloud-based) analysis and/or decisionsupport platform); (c) access, for each selected file, the associatedmetadata of the file and identifying, among the plurality of dataelements of the associated metadata, one or more flagged data elementsfor de-identification prior to upload; (d) create, for each selectedfile, de-identified metadata corresponding to the associated metadata ofthe file with values of the flagged data elements removed and/or masked(e.g., replaced with a masking value that obscures the original valueand/or conveys more limited information); (e) receive (e.g., via theGUI), a user selection of a particular file for review ofde-identification; (f) responsive to the user selection of theparticular file, cause (e.g., via the GUI) display of a graphicalrepresentation of metadata changes comprising a listing of the pluralityof data elements of the associated metadata of the particular file and avisual indication of the one or more flagged data elements (e.g.,identifying flagged data elements in particular colors, text formatting,etc. so as to visually distinguish from other data elements, placingcolor coded icons/indicators in proximity to flagged data elements,etc.); (g) receive a user confirmation to upload; and (h) (e.g.,responsive to the receipt of the user confirmation to upload) uploadeach selected file with the original associated metadata replaced withthe corresponding de-identified metadata, to the network-based platform.

In certain embodiments, the instructions cause the processor to: (i)cause (e.g., via the GUI; e.g., responsive to receipt of a user input todisplay de-identified metadata) display of a graphical representation ofthe de-identified metadata that corresponds to the associated metadataof the particular file.

In certain embodiments, the instructions cause the processor to: (j)cause (e.g., via the GUI; e.g., responsive to receipt of a user input todisplay original metadata) display of a graphical representation oforiginal associated metadata of the particular file (e.g., without thevisual indication of the one or more flagged data elements).

In certain embodiments, at least a portion of the flagged data elementsare identified as elements to be masked by, for each element to bemasked, replacing an initial value of the element to be masked with aparticular masking value, and wherein the graphical representation ofmetadata changes further comprises, for each element to be masked, anindication of the initial value of the element and an indication of theparticular masking value for the element.

In certain embodiments, in the graphical representation of metadatachanges, the listing of the plurality of data elements of the associatedmetadata is displayed in a table [(e.g., each data element displayed ina row, with an indication of its value) (e.g., wherein each flagged dataelement is identified via a colored indicator (e.g., a red indicatordisplayed next to elements to be removed and/or masked)(e.g., wherein,for each particular data element identified as elements to be masked, anadditional row showing the masking value for that particular dataelement included below the row for that particular data element)].

In certain embodiments, at least a portion of the flagged data elementsare identified as elements to be masked (e.g., as opposed to removed)and wherein at step (c), the instructions cause the processor to, foreach element to be masked, replace an initial value of the element to bemasked with a particular masking value.

In certain embodiments, at step (c) the instructions cause the processorto access a stored de-identification protocol comprising a listing ofdata elements to flag.

In certain embodiments, the instructions cause the processor to: receive(e.g., via the GUI), a user selection of one or more additional dataelements to flag for de-identification; and update the de-identified setof metadata associated with each medical image to remove and/or mask avalue of each selected additional data element.

In certain embodiments, the one or more flagged data elements compriseone or more members selected from the group consisting of: a patientname, a patient identifier [e.g., a unique (e.g., numeric oralphanumeric) identifier assigned to the patient)], a patient birthdate.

In certain embodiments, the local computing device is in communication(e.g., connected to via data acquisition/instrument control hardwareand/or channels, such as USB, serial, Ethernet/local area network (LAN),general purpose interface bus (GPIB), etc.; e.g., in communication overa network (e.g., a local private network)] with an imaging system [e.g.,a computed tomography (CT) scanner; e.g., a magnetic resonance imaging(MRI) scanner; e.g., a positron emission tomography (PET) scanner; e.g.,a single photon emission computed tomography (SPECT) scanner; e.g., agamma camera scanner (e.g., a scintigraphy imaging scanner); e.g., acombined CT/PET, CT/SPECT, MRI/PET, MRI/SPECT scanner]. In certainembodiments, the system further comprising the imaging system.

In certain embodiments, the local computing device is on a local network(e.g., a private, limited access network, such as a network of ahospital or group of hospitals, a network of a research organization,and the like) that is not part of the network-based (e.g., acloud-based) analysis and/or decision support platform.

In certain embodiments, the instructions cause the processor to:following step (b), perform a pre-processing step (e.g., apre-processing software routine) to validate each of the one or moreselected files for upload (e.g., to confirm that each selected filecomprises a medical image of a particular type and/or format).

In certain embodiments, the instructions cause the processor to:identify, for each file, a corresponding study to which the filebelongs, thereby identifying one or more processed studies; and causedisplay of (e.g., via the GUI) a graphical representation of processedstudies comprising a listing of the one or more processed studies [e.g.,wherein the processed studies are displayed in tabular format with eachprocessed study shown in a different row].

In certain embodiments, the graphical representation of processedstudies comprises, for each processed study, a visual indication of anumber of different files (e.g., a rendered numerical value in a row) ofthe study along with a visual indication of one or more imagingmodalities used to obtain medical images of the files belonging to thestudy (e.g., rendered text and/or icons representing particular imagingmodalities).

In certain embodiments, the instructions cause the processor to: receivea user input to review images of a particular study; and cause displayof (e.g., via the GUI) a first medical image of a first file andcorresponding to (e.g., obtained using) a particular imaging modality,along with a graphical control element that allows the user to viewadditional images (i) of files belong to the particular study and (ii)also corresponding to the particular imaging modality (e.g., therebyallowing the user to conveniently scroll through images of theparticular study and corresponding to the particular imaging modality).

In another aspect, the invention is directed to a method for interactivedisplay of data representing medical imaging studies uploaded to anetwork-based (e.g., a cloud-based) analysis and/or decision supportplatform via a graphical user interface (GUI), the method comprising:(a) accessing, by a processor of a computing device (e.g., of thenetwork-based platform), a data table comprising, for each of aplurality of study summary variables, a set of values of the studysummary variable, each value of the set associated with a particularmedical imaging study previously uploaded to (e.g., now stored on) thenetwork-based platform, wherein the study summary variables comprise oneor more members selected from the group consisting of: a prior therapyvalue (e.g., a binary value representing whether or not a particularpatient has had prior prostate cancer therapy), a prostate cancerindication [e.g., a value (e.g., an integer; e.g., an enumerateddata-type; e.g., a character or string) representing one of a set ofindications for categorizing a patient and/or their cancer status, suchas screening, recurrent, suspected recurrence, newly-diagnosed,metastatic, and other], a prostate-specific antigen (PSA) test level(e.g., a numeric value), and an imaging modality [e.g., a value (e.g.,an integer; e.g., an enumerated data-type; e.g., a character or string)representing one of a set of imaging modalities (e.g., CT, PET, SPECT,MRI, bone-scan, etc.)]; (b) causing, by the processor (e.g., of thenetwork-based platform), display of a graphical user interface (GUI)comprising: (i) a plurality of graphical filter control elements, eachgraphical filter control element corresponding to a particular studysummary variable and providing for a user selection of a sub-range(e.g., selected the sub-range may be, but is not necessarily, acontinuous range and, for variables having discrete or enumeratedvalues, may be a list of possible values) of values of the particularstudy summary variable; and (ii) a plurality of graphical datarepresentations, each graphical data representation corresponding to astudy summary variable and providing a visual representation ofdistribution of the set of values of the study summary variable in thedata table (e.g., a bar graph; e.g., a pie chart; e.g., a histogram);(c) receiving, by the processor (e.g., of the network-based platform),via a particular graphical filter control element, a user selection of asub-range for values of the corresponding particular study summaryvariable, and using the selected sub-range as a filter to identify,within the data table, for each specific study summary variable, afiltered sub-set of values of the specific study summary variablecomprising only those values that are associated with uploaded medicalimaging studies which are themselves also associated with those valuesof the particular study summary variable falling within the selectedsub-range; and (d) causing, by the processor (e.g., of the network-basedplatform), graphical rendering (e.g., for display) of an updated versionof the each of the graphical data representations, each providing avisual representation of distribution of values in the filtered sub-setof the corresponding study summary variable (e.g., and causing, by theprocessor, display of, via the GUI, the updated versions of thegraphical data representations).

In certain embodiments, the method comprises performing step (c)repeatedly, for a plurality of different graphical filter controlelements to use sub-ranges of multiple study summary variables asfilters.

In another aspect the invention is directed to a system for interactivedisplay of data representing medical imaging studies uploaded to anetwork-based (e.g., a cloud-based) analysis and/or decision supportplatform via a graphical user interface (GUI), the system , the systemcomprising: a processor of a computing device; and a memory havinginstructions stored thereon, wherein the instructions, when executed bythe processor, cause the processor to: (a) access, a data tablecomprising, for each of a plurality of study summary variables, a set ofvalues of the study summary variable, each value of the set associatedwith a particular medical imaging study previously uploaded to (e.g.,now stored on) the network-based platform, wherein the study summaryvariables comprise one or more members selected from the groupconsisting of: a prior therapy value (e.g., a binary value representingwhether or not a particular patient has had prior prostate cancertherapy), a prostate cancer indication [e.g., a value (e.g., an integer;e.g., an enumerated data-type; e.g., a character or string) representingone of a set of indications for categorizing a patient and/or theircancer status, such as screening, recurrent, suspected recurrence,newly-diagnosed, metastatic, and other], a prostate-specific antigen(PSA) test level (e.g., a numeric value), and an imaging modality [e.g.,a value (e.g., an integer; e.g., an enumerated data-type; e.g., acharacter or string) representing one of a set of imaging modalities(e.g., CT, PET, SPECT, MRI, bone-scan, etc.)]; (b) cause display of agraphical user interface (GUI) comprising: (i) a plurality of graphicalfilter control elements, each graphical filter control elementcorresponding to a particular study summary variable and providing for auser selection of a sub-range (e.g., selected the sub-range may be, butis not necessarily, a continuous range and, for variables havingdiscrete or enumerated values, may be a list of possible values) ofvalues of the particular study summary variable; and (ii) a plurality ofgraphical data representations, each graphical data representationcorresponding to a study summary variable and providing a visualrepresentation of distribution of the set of values of the study summaryvariable in the data table (e.g., a bar graph; e.g., a pie chart; e.g.,a histogram); (c) receive, via a particular graphical filter controlelement, a user selection of a sub-range for values of the correspondingparticular study summary variable, and using the selected sub-range as afilter to identify, within the data table, for each specific studysummary variable, a filtered sub-set of values of the specific studysummary variable comprising only those values that are associated withuploaded medical imaging studies which are themselves also associatedwith those values of the particular study summary variable fallingwithin the selected sub-range; and (d) cause graphical rendering (e.g.,for display) of an updated version of the each of the graphical datarepresentations, each providing a visual representation of distributionof values in the filtered sub-set of the corresponding study summaryvariable (e.g., and causing, by the processor, display of, via the GUI,the updated versions of the graphical data representations).

In certain embodiments, the instructions cause the processor to performstep (c) repeatedly, for a plurality of different graphical filtercontrol elements to use sub-ranges of multiple study summary variablesas filters.

Features of embodiments described with respect to one aspect of theinvention may be applied with respect to another aspect of theinvention.

BRIEF DESCRIPTION OF THE DRAWING

The foregoing and other objects, aspects, features, and advantages ofthe present disclosure will become more apparent and better understoodby referring to the following description taken in conjunction with theaccompanying drawing, in which:

FIG. 1A is a screenshot of a graphical user interface (GUI) for allowinga user to upload files comprising medical images to a cloud-basedplatform, according to an illustrative embodiment;

FIG. 1B is another screenshot of the GUI shown in FIG. 1A, showing aview that appears after a user has selected files for upload, accordingto an illustrative embodiment;

FIG. 1C is another screenshot of the GUI shown in FIG. 1A, showinganother view that appears after a user has selected files for upload,according to an illustrative embodiment;

FIG. 1D is another screenshot of the GUI shown in FIG. 1A, showinganother view that appears after a user has selected files for upload,according to an illustrative embodiment;

FIG. 1E is another screenshot of the GUI shown in FIG. 1A, showinganother view that appears after a user has selected files for upload,according to an illustrative embodiment;

FIG. 2A is another screenshot of the GUI shown in FIG. 1A, showing aview of a pop-up window that allows a user to review a specific medicalimage and its associated metadata, according to an illustrativeembodiment;

FIG. 2B is another screenshot of the GUI shown in FIG. 1A, showinganother view of the pop-up window that allows a user to review aspecific medical image and its associated metadata, according to anillustrative embodiment;

FIG. 2C is another screenshot of the GUI shown in FIG. 1A, showinganother view of the pop-up window that allows a user to review aspecific medical image and its associated metadata, according to anillustrative embodiment;

FIG. 3A is another screenshot of the GUI shown in FIG. 1A, showinganother view of the pop-up window, comprising a graphical representationof metadata associated with a specific medical image, according to anillustrative embodiment;

FIG. 3B is another screenshot of the GUI shown in FIG. 1A, showinganother view of the pop-up window, comprising a graphical representationof metadata associated with a specific medical image, according to anillustrative embodiment;

FIG. 3C is another screenshot of the GUI shown in FIG. 1A, showinganother view of the pop-up window, comprising a graphical representationof metadata associated with a specific medical image, according to anillustrative embodiment;

FIG. 3D is another screenshot of the GUI shown in FIG. 1A, showinganother view of the pop-up window, comprising a graphical representationof metadata associated with a specific medical image, according to anillustrative embodiment;

FIG. 4A is another screenshot of the GUI shown in FIG. 1A, showing aview that allows a user to enter supplemental data, according to anillustrative embodiment;

FIG. 4B is another screenshot of the view of the GUI shown in FIG. 4A,showing entered supplemental data, according to an illustrativeembodiment;

FIG. 4C is another screenshot of the view of the GUI shown in FIG. 4A,showing a pop-up window prompting a user to confirm entered supplementaldata, according to an illustrative embodiment;

FIG. 5 is another screenshot of the view of the GUI shown in FIG. 4A,showing an indication of successful upload;

FIG. 6A is another screenshot of the GUI shown in FIG. 1A, showing aview that allows a user to inspect uploaded medical image data;

FIG. 6B is another screenshot of the GUI view shown in FIG. 6A,according to an illustrative embodiment;

FIG. 6C is another screenshot of the GUI view shown in FIG. 6A,according to an illustrative embodiment;

FIG. 6D is another screenshot of the GUI view shown in FIG. 6A,according to an illustrative embodiment;

FIG. 7A is a screenshot of a GUI, showing a view that allows a user toinspect uploaded medical image data;

FIG. 7B is another screenshot of the GUI shown in FIG. 7A, showing aview that allows a user to interactively view and apply filters tographical representations of study summary data from uploaded medicalimaging studies;

FIG. 7C is another screenshot of the view of the GUI shown in FIG. 7B,showing a user interaction with one of the graphical representations ofstudy summary data;

FIG. 7D is another screenshot of the view of the GUI shown in FIG. 7B,showing a updates to the graphical representations following filteringof data via a user interaction with a graphical filter control element;

FIG. 7E is another screenshot of the view of the GUI shown in FIG. 7B,showing a user interaction with a graphical filter control element;

FIG. 7F is another screenshot of the view of the GUI shown in FIG. 7B,showing a updates to the graphical representations following filteringof data via a user interaction with a graphical filter control element;

FIG. 8 is a block flow diagram of a process for secure upload of medicalimages and associated metadata from a local computing device to anetwork-based platform, according to an illustrative embodiment;

FIG. 9 is a block flow diagram of a processes for interactive display ofdata representing uploaded medical imaging studies, according to anillustrative embodiment;

FIG. 10 is a block diagram of an exemplary cloud computing environment,used in certain embodiments; and

FIG. 11 is a block diagram of an example computing device and an examplemobile computing device used in certain embodiments.

The features and advantages of the present disclosure will become moreapparent from the detailed description set forth below when taken inconjunction with the drawings, in which like reference charactersidentify corresponding elements throughout. In the drawings, likereference numbers generally indicate identical, functionally similar,and/or structurally similar elements.

Definitions

Administering: As used herein, “administering” an agent meansintroducing a substance (e.g., an imaging agent) into a subject. Ingeneral, any route of administration may be utilized including, forexample, parenteral (e.g., intravenous), oral, topical, subcutaneous,peritoneal, intraarterial, inhalation, vaginal, rectal, nasal,introduction into the cerebrospinal fluid, or instillation into bodycompartments.

Image: As used herein, the term “image”, for example, as in athree-dimensional image of a patient, includes any visualrepresentation, such as a photo, a video frame, streaming video, as wellas any electronic, digital, or mathematical analogue of a photo, videoframe, or streaming video. Any apparatus described herein, in certainembodiments, includes a display for displaying an image or any otherresult produced by a processor. Any method described herein, in certainembodiments, includes a step of displaying an image or any other resultproduced by the method.

Radionuclide: As used herein, “radionuclide” refers to a moietycomprising a radioactive isotope of at least one element. Exemplarysuitable radionuclides include but are not limited to those describedherein. In some embodiments, a radionuclide is one used in positronemission tomography (PET). In some embodiments, a radionuclide is oneused in single-photon emission computed tomography (SPECT). In someembodiments, a non-limiting list of radionuclides includes ^(99m)Tc,¹¹¹In, ⁶⁴Cu, ⁶⁷Ga, ⁶⁸Ga, ¹⁸⁸Re, ¹⁵³Sm, ¹⁷⁷Lu, ⁶⁷Cu, ¹²³I, ¹²⁴I, ¹²⁵I,¹²⁶I, ¹³¹I, ¹¹ _(C,) ¹³N, ¹⁵O, ¹⁸F, ¹⁵³Sm, ¹⁶⁶Ho, ¹⁷⁷Lu, ¹⁴⁹Pm, ⁹⁰Y,²¹³Bi, ¹⁰³Pd, ¹⁰⁹Pd, ¹⁵⁹Gd, ¹⁴⁰La, ¹⁹⁸Au, ¹⁹⁹Au, ¹⁹⁹Yb, ¹⁷⁵Yb, ¹⁶⁵Yb,¹⁶⁶Dy, ¹⁰⁵Rh, ¹¹¹Ag, ⁸⁹Zr, ²²⁵AC, ⁸²Rb, ⁷⁵Br, ⁷⁶Br, ⁷⁷Br, ⁸⁰Br,^(80m)Br, ⁸²Br, ⁸³Br, ²¹¹At and ¹⁹²Ir.

Radiopharmaceutical: As used herein, the term “radiopharmaceutical”refers to a compound comprising a radionuclide. In certain embodiments,radiopharmaceuticals are used for diagnostic and/or therapeuticpurposes. In certain embodiments, radiopharmaceuticals include smallmolecules that are labeled with one or more radionuclide(s), antibodiesthat are labeled with one or more radionuclide(s), and antigen-bindingportions of antibodies that are labeled with one or moreradionuclide(s).

3D, three-dimensional: As used herein, “3D” or “three-dimensional” withreference to an “image” means conveying information about three spatialdimensions. A 3D image may be rendered as a dataset in three dimensionsand/or may be displayed as a set of two-dimensional representations, oras a three-dimensional representation. In certain embodiments, a 3-Dimage is represented as voxel (e.g., volumetric pixel) data.

DETAILED DESCRIPTION

It is contemplated that systems, architectures, devices, methods, andprocesses of the claimed invention encompass variations and adaptationsdeveloped using information from the embodiments described herein.Adaptation and/or modification of the systems, architectures, devices,methods, and processes described herein may be performed, ascontemplated by this description.

Throughout the description, where articles, devices, systems, andarchitectures are described as having, including, or comprising specificcomponents, or where processes and methods are described as having,including, or comprising specific steps, it is contemplated that,additionally, there are articles, devices, systems, and architectures ofthe present invention that consist essentially of, or consist of, therecited components, and that there are processes and methods accordingto the present invention that consist essentially of, or consist of, therecited processing steps.

It should be understood that the order of steps or order for performingcertain action is immaterial so long as the invention remains operable.Moreover, two or more steps or actions may be conducted simultaneously.

The mention herein of any publication, for example, in the Backgroundsection, is not an admission that the publication serves as prior artwith respect to any of the claims presented herein. The Backgroundsection is presented for purposes of clarity and is not meant as adescription of prior art with respect to any claim.

Documents are incorporated herein by reference as noted. Where there isany discrepancy in the meaning of a particular term, the meaningprovided in the Definition section above is controlling.

Headers are provided for the convenience of the reader—the presenceand/or placement of a header is not intended to limit the scope of thesubject matter described herein.

A. Secure Upload of Medical Images

Described herein are systems and methods that provide for secure uploadof files comprising medical images and associated metadata from a localcomputing device to a network-based platform.

Storing and analyzing medical images using cloud-based platforms isattractive, since cloud-based platforms offer significant advantagesover keeping files on local computing devices. Cloud-based systemsfacilitate communication between and allow data to be readily accessedby different sites, such different hospitals, clinics, and researchfacilities. Moreover, they offer the ability to shift the burden ofmaintaining a complex computing network to a third party, allowingfacilities to dedicate resources to activities more in line with theirprimary purpose, such as providing medical care and/or carrying outresearch. At the same time, cloud-based platforms often providesignificant improvements in computing capabilities.

For example, a cloud based platform can serve as a repository formedical images collected for multiple patients over the course years ofcare, involving, for example, disease diagnosis, and treatmentmonitoring, or during clinical trials. Moreover, such platforms mayserve as a hub, not only providing for storage and/or accessing ofmedical images, but also providing tools for computer aided imageanalysis. For example, PCT Appl. PCT/US17/58418, filed Oct. 26, 2017(publication no. WO/2018/081354), the content of which is incorporatedherein by reference in its entirety, provides examples of cloud-basedimage analysis platforms that allow a user to upload images, accessthem, and analyze them using various tools, suited for different imagingmodalities. For example, once images are uploaded, bone-scan imageanalysis tools, such as aBSI (automated bone scan index), can be used toevaluate disease burden and identify metastases from scintigraphyimages. Other image analysis tools, suited for analyzing threedimensional images such as SPECT/CT and PET/CT composite images Forexample, PCT Applications PCT/US19/12486, filed Jan. 7, 2019(publication no. WO/2019/136349) and PCT/EP2020/050132, filed Jan. 6,2020 (publication no. WO/2020/144134), the content of each of which arehereby incorporated by reference in their entirety, describe 3D imagesegmentation techniques and processing approaches that can be used toevaluate uptake of various radiopharmaceuticals in specific organs ofinterest and/or identify hotspots in functional images (e.g., PET, SPECTimages) that represent cancerous lesions. Accordingly, utilizing suchcloud-based platforms streamlines image storage and analysis, andfacilitates access to valuable analysis tools.

Despite the advantages of cloud based platforms, security of privatemedical data is an important concern. The ability to ensure thatsensitive private data, such as information that could be used toascertain the identify of a particular patient to which various recordsbelong, is kept private, and not transmitted to other parties is animportant requirement for use of data-sharing and cloud-based systems.In many cases, for example particularly where data is shared and/or usedfor research purposes, sensitive data can and must be removed to ensurethat any medical data cannot identified as belonging to a particularindividual (e.g., patient).

Ensuring adherence to such privacy controls is non-trivial, andapproaches that facilitate maintaining data privacy and allow users tointeract with cloud-based systems confidently are highly desirable.Accordingly, in certain embodiments, the systems and methods describedherein allow a user to upload files comprising medical images to acloud-based image analysis platform while maintaining appropriateprivacy controls by de-identifying portions of metadata associated withmedical images prior to upload. In particular, approaches describedherein prevent the network-based platform from accessing sensitive dataas it is prepared for upload. Prior to file upload, sensitive elementsare identified and flagged and their values removed and/or masked.Notably, in certain embodiments, the approaches described herein providefor graphical user interfaces (GUIs) that allow a user to visuallyinspect and control the de-identification of metadata prior to upload inan intuitive manner.

Processing performed to display the GUI elements, view data prior toupload, and de-identify data by identifying and removing and/or maskingvalues of flagged data elements are performed by a processor of a localcomputing device that is not part of the network-based platform to whichfiles are uploaded. In certain embodiments, the local computing deviceis in communication with an imaging system [e.g., a computed tomography(CT) scanner; e.g., a magnetic resonance imaging (MRI) scanner; e.g., apositron emission tomography (PET) scanner; e.g., a single photonemission computed tomography (SPECT) scanner; e.g., a gamma camerascanner (e.g., a scintigraphy imaging scanner); e.g., a combined CT/PET,CT/SPECT, MRI/PET, MRI/SPECT scanner]. In certain embodiments, the localcomputing device on a local network (e.g., a private, limited accessnetwork, such as a network of a hospital or group of hospitals, anetwork of a research organization, and the like) that is not part ofthe network-based (e.g., a cloud-based) analysis and/or decision supportplatform.

As described herein, in certain embodiments the systems and methodsdescribed herein provide for analysis and secure upload of nuclearmedicine images. Nuclear medicine images are obtained using a nuclearimaging modality such as bone scan imaging, Positron Emission Tomography(PET) imaging, and Single-Photon Emission Tomography (SPECT) imaging.

In certain embodiments, nuclear medicine images use imaging agentscomprising radiopharmaceuticals. Nuclear medicine images are obtainedfollowing administration of a radiopharmaceutical to a patient (e.g., ahuman subject), and provide information regarding the distribution ofthe radiopharmaceutical within the patient. Radiopharmaceuticals arecompounds that comprise a radionuclide.

Nuclear medicine images (e.g., PET scans; e.g., SPECT scans; e.g.,whole-body bone scans; e.g. composite PET-CT images; e.g., compositeSPECT-CT images) detect radiation emitted from the radionuclides ofradiopharmaceuticals to form an image. The distribution of a particularradiopharmaceutical within a patient may be determined by biologicalmechanisms such as blood flow or perfusion, as well as by specificenzymatic or receptor binding interactions. Differentradiopharmaceuticals may be designed to take advantage of differentbiological mechanisms and/or particular specific enzymatic or receptorbinding interactions and thus, when administered to a patient,selectively concentrate within particular types of tissue and/or regionswithin the patient. Greater amounts of radiation are emitted fromregions within the patient that have higher concentrations ofradiopharmaceutical than other regions, such that these regions appearbrighter in nuclear medicine images. Accordingly, intensity variationswithin a nuclear medicine image can be used to map the distribution ofradiopharmaceutical within the patient. This mapped distribution ofradiopharmaceutical within the patient can be used to, for example,infer the presence of cancerous tissue within various regions of thepatient's body.

For example, upon administration to a patient, technetium 99 mmethylenediphosphonate (^(99m)Tc MDP) selectively accumulates within theskeletal region of the patient, in particular at sites with abnormalosteogenesis associated with malignant bone lesions. The selectiveconcentration of radiopharmaceutical at these sites producesidentifiable hotspots—localized regions of high intensity in nuclearmedicine images. Accordingly, presence of malignant bone lesionsassociated with metastatic prostate cancer can be inferred byidentifying such hotspots within a whole-body scan of the patient. Asdescribed in the following, risk indices that correlate with patientoverall survival and other prognostic metrics indicative of diseasestate, progression, treatment efficacy, and the like, can be computedbased on automated analysis of intensity variations in whole-body scansobtained following administration of ^(99m)Tc MDP to a patient. Incertain embodiments, other radiopharmaceuticals can also be used in asimilar fashion to ^(99m)Tc MDP.

In certain embodiments, the particular radiopharmaceutical used dependson the particular nuclear medicine imaging modality used. For example 18F sodium fluoride (NaF) also accumulates in bone lesions, similar to^(99m)Tc MDP, but can be used with PET imaging. In certain embodiments,PET imaging may also utilize a radioactive form of the vitamin choline,which is readily absorbed by prostate cancer cells.

In certain embodiments, radiopharmaceuticals that selectively bind toparticular proteins or receptors of interest—particularly those whoseexpression is increased in cancerous tissue may be used. Such proteinsor receptors of interest include, but are not limited to tumor antigens,such as CEA, which is expressed in colorectal carcinomas, Her2/neu,which is expressed in multiple cancers, BRCA 1 and BRCA 2, expressed inbreast and ovarian cancers; and TRP-1 and -2, expressed in melanoma.

For example, human prostate-specific membrane antigen (PSMA) isupregulated in prostate cancer, including metastatic disease. PSMA isexpressed by virtually all prostate cancers and its expression isfurther increased in poorly differentiated, metastatic and hormonerefractory carcinomas. Accordingly, radiopharmaceuticals correspondingto PSMA binding agents (e.g., compounds that a high affinity to PSMA)labelled with one or more radionuclide(s) can be used to obtain nuclearmedicine images of a patient from which the presence and/or state ofprostate cancer within a variety of regions (e.g., including, but notlimited to skeletal regions) of the patient can be assessed. In certainembodiments, nuclear medicine images obtained using PSMA binding agentsare used to identify the presence of cancerous tissue within theprostate, when the disease is in a localized state. In certainembodiments, nuclear medicine images obtained using radiopharmaceuticalscomprising PSMA binding agents are used to identify the presence ofcancerous tissue within a variety of regions that include not only theprostate, but also other organs and tissue regions such as lungs, lymphnodes, and bones, as is relevant when the disease is metastatic.

In particular, upon administration to a patient, radionuclide labelledPSMA binding agents selectively accumulate within cancerous tissue,based on their affinity to PSMA. In a similar manner to that describedabove with regard to ^(99m)Tc MDP, the selective concentration ofradionuclide labelled PSMA binding agents at particular sites within thepatient produces detectable hotspots in nuclear medicine images. As PSMAbinding agents concentrate within a variety of cancerous tissues andregions of the body expressing PSMA, localized cancer within a prostateof the patient and/or metastatic cancer in various regions of thepatient's body can be detected, and evaluated. Risk indices thatcorrelate with patient overall survival and other prognostic metricsindicative of disease state, progression, treatment efficacy, and thelike, can be computed based on automated analysis of intensityvariations in nuclear medicine images obtained following administrationof a PSMA binding agent radiopharmaceutical to a patient.

A variety of radionuclide labelled PSMA binding agents may be used asradiopharmaceutical imaging agents for nuclear medicine imaging todetect and evaluate prostate cancer. In certain embodiments, theparticular radionuclide labelled PSMA binding agent that is used dependson factors such as the particular imaging modality (e.g., PET; e.g.,SPECT) and the particular regions (e.g., organs) of the patient to beimaged. For example, certain radionuclide labelled PSMA binding agentsare suited for PET imaging, while others are suited for SPECT imaging.For example, certain radionuclide labelled PSMA binding agentsfacilitate imaging a prostate of the patient, and are used primarilywhen the disease is localized, while others facilitate imaging organsand regions throughout the patient's body, and are useful for evaluatingmetastatic prostate cancer.

A variety of PSMA binding agents and radionuclide labelled versionsthereof are described in U.S. Pat. Nos. 8,778,305, 8,211,401, and8,962,799, each of which are incorporated herein by reference in theirentireties. Several PSMA binding agents and radionuclide labelledversions thereof are also described in PCT ApplicationPCT/US2017/058418, filed Oct. 26, 2017 (PCT publication WO 2018/081354),the content of which is incorporated herein by reference in itsentirety.

A. i. Selection and Pre-Processing of Files

For example, FIG. 1A shows a screenshot of an initial view of a GUI 100that allows a user to select, review, and upload files comprisingmedical images and associated metadata. As shown in FIG. 1A, a user mayselect files via an intuitive ‘drag-and-drop’ approach (e.g., bydragging files on their local computing device into window 102), orclick link 104 to browse for files via a traditional file explorer.Following user selection of files to upload, the user selected files arepre-processed and validated. In certain embodiments, files correspondingto a same study are grouped together. For example, as shown in FIG. 1B,multiple processed files may be grouped together into a single study. Asshown in the GUI view of FIG. 1B, selectable graphical control elementsmay be displayed in order to allow a user to inspect processed studies,individual files, as well as files determined to be invalid during thepreprocessing step. In the view shown in FIG. 1B, the Processed Studiesselectable element 106 is selected and a listing of processed studies isshown below. Only a single study is shown in FIG. 1B, but multiplestudies may be shown as well. Icon 112 represents the processed study,and includes a selectable icon 114 representing a set of filescorresponding to the study. Icon 114 indicates a particular type ofimage—a PET image, and shows the number “(3)”, indicating the threefiles comprising PET image data processed.

As shown in FIG. 1C, following a user selection of selectable element108 causes display of a listing of individual processed files, with eachprocessed file represented by an icon 116 a, 116 b, and 116 c. The icons116 a, 116 b, and 116 c show information about the processed files, suchas the filename, a patient name, and an indication of the imagingmodality used to obtain the medical image of the file.

FIG. 1D shows a view that appears upon a user selection of selectableelement 110 to display files identified as invalid during preprocessing.As shown in FIG. 1D, each invalid file is identified by an icon—e.g.,icons 118 a, 118 b, 118 c, 118 d, 118 e, 118 f, and 118 g.

FIG. 1E shows another view of the GUI, similar to FIG. 1C, in which allfiles were successfully processed, and no files were found invalid.Icons 116 a, 116 b, 116 c, 116 d, 116 e, and 116 f represent thedifferent processed files. As shown in FIG. 1E, medical images obtainedusing different modalities are selected. In particular, filesrepresented by icons 116 a, 116 b, 116 e, and 116 f comprise medicalimages obtained via PET imaging (e.g., they are labeled with theidentifier “PT”) and files represented by icons 116 c and 116 d comprisemedical images obtained using CT imaging (e.g., they are labeled withthe identifier “CT”).

A. ii. Review of Medical Images and Associated Metadata

In certain embodiments, a user can click icon 114 (shown in FIG. 1B) toreview files comprising the medical images. As shown in FIG. 2A,following the user click on icon 114, window 200 is displayed (e.g., asan overlay, as shown in FIG. 2A, or in other manners, e.g., as aseparate window, in a separate browser tab, etc.), allowing the user toreview medical images and associated metadata within the files. Window200 includes an initial display of a first medical image 202 a of afirst set of medical images. Window 200 also includes graphical controlelements 204 a, 204 b, for scrolling through different images in a setof multiple related images. For example, a user click may click onelement 204 b to move to a next image in a set, bringing up image 202 bshown in FIG. 2B. A user may also click element 208 to view other setsof medical images, for example to view images collected using adifferent imaging modality. For example, upon selecting the secondelement 208 b of the popup shown in FIG. 2B that appears when a userclicks on element 208, a CT image 202 c is shown. Other sets of imagescan be viewed by clicking other elements of the popup, e.g., 208 a, 208c for different sets of PET images.

A user may also click on text “Attributes” 206 b to view associatedmetadata to review de-identification. Upon the user selection to reviewde-identification, a graphical representation 210 of associated metadataof a particular file is displayed. The associated metadata includesvarious individual data elements, which are displayed in a tabularfashion. A user may scroll through the table to view different dataelements as shown in FIG. 3A and FIG. 3B.

Three different views of associated metadata are available. A user mayselect between the different views via control elements (e.g., radiobuttons) 212 a, 212 b, and 212 c.

One view, “changes” conveys changes made or that will be made to theassociated metadata in order to remove and/or mask values of certainsensitive data elements that convey information that could be used toidentify a particular patient. Prior to upload, such sensitive dataelements are identified in the associate metadata in each file, andflagged for de-identification. For each flagged data element, the valueof that element is either removed or replaced with a masking value thatobscures and/or convey more limited information than the value itself.Certain flagged elements may be removed entirely, while others may bemasked. The particular protocol listing which elements to flag, and inturn, which flagged elements are to be removed and which are to bemasked, may be stored in an accessible protocol file (e.g., on the localcomputing device).

As shown in FIG. 3A and FIG. 3B, flagged data elements are visuallyindicated via a colored bar. Various other approaches for visuallyidentifying and displaying flagged data elements are also possible. Forexample, other colorization schemes can be used, entire rows of thetable could be highlighted, different fonts or colors of text used,other icons (e.g., as opposed to colored bars) used. Red colored barsindicate elements to be removed, while green bars signifyadditions—namely, masking values replacing the original initial value ofcertain particular data elements. Accordingly, data elements to bemasked are observable as pairs of like named elements identified by ared and then, below, a green, bar. For example, in FIG. 3A rows 222 aand 222 b show that a value of the data element named “SOPlnstanceUID”is removed and replaced with masking value. Similarly, rows 226 a and226 b show that the data element called “PatientName” is masked, androws 228 a and 228 b show that the data element called “PatientID” ismasked. Rows 224, 230, 232, and 234, flagged in red without acorresponding added entry beneath signify data elements that are removedentirely. Accordingly, this intuitive graphical display of metadatachanges informs the user of how the data that they upload will bede-identified, and allows them to ensure appropriate privacy controlsare taken.

As shown in FIG. 3C and FIG. 3D, a user may also view de-identifiedmetadata as well as the original metadata (e.g., for comparison) viabuttons 212 b and 212 c, respectively.

A. iii. File Upload

Turning to FIG. 4A, in certain embodiments, once a user has competedreview of their selected files, a view appears 400 in which they areprompted to enter supplemental data for each study. Once the user enterssupplemental data, they may be prompted to review the supplemental dataas shown in FIG. 4B. The user may then initiate upload via button 402. Ashown in FIG. 4C, in certain embodiments (e.g., as a precaution), adialog box 404 is displayed requiring a user to confirm 406 a theupload. The user may, alternatively, select cancel 406 b to cancel theupload and return to the previous views of the GUI. Provided the userselects confirm 406 a, the selected files are uploaded, with theoriginal associated metadata replaced with corresponding de-identifiedmetadata. FIG. 5 shows an example screen 500 displayed confirmingsuccessful completion of file upload.

As shown in FIGS. 6A-6D, once files are uploaded, a user may browseuploaded data to which they have permission to access. As shown in FIGS.6A-6D, data may be organized and grouped according to studies. A usermay search for particular data files in a flexible manner, by enteringvarious criteria, such as a cancer indication (FIG. 6B), a diagnosticmeasurement value, such as a prostate specific membrane antigen (PSA)value (FIG. 6C), a particular imaging modality (FIG. 6D), and otherparameters.

Turning to FIGS. 7A-7F, a user may also (e.g., by selecting “All Data”as shown in FIG. 7A) view and interact with graphical representations ofdata summarizing the medical imaging studies uploaded to the cloud-basedplatform. As shown in FIGS. 7B-7F, the GUI allows a user to viewdistributions of study summary variables corresponding to prior therapy,prostate cancer indication, PSA interval, and imaging modality. The GUIcomprises a plurality of graphical filter control elements eachcorresponding to a particular study summary variable. A user may use thegraphical filter control elements to select sub-ranges of various studysummary variables to use to filter the displayed graphicalrepresentations of the data distributions (as used in this sense, theterm sub-range does not necessarily refer to a continuous range—it maybe piece-wise continuous or, for, variables having a discrete set ofvalues, a list of specific values).

B. Processes for Displaying GUI Tools, Uploading De-Identified MedicalImage Files, and Interactive Data Representation Display

An example process 800 performed by a local computing device toproviding interactive GUI tools that facilitate secure upload of filescomprising medical images and associated metadata in accordance with thesystems and methods described herein is shown in FIG. 8 . In a firststep 802, the local computing device causes display of the GUI thatguides the user through image upload and allows them to review theirdata, as described herein. The processor receives (e.g., via the GUI) auser selection of files comprising medical images and associatedmetadata 804. The processor accesses, for each selected file, associatedmetadata of the file and identifies sensitive data elements to beflagged for de-identification prior to upload 806. The processor thencreates, for each selected file de-identified metadata corresponding tothe original associated metadata with values of the flagged dataelements removed and/or masked.

In order to allow a user to review metadata and the de-identificationprocess, a user selection of a particular file to review is received810, and a graphical representation of associated metadata is caused tobe displayed 812. For example, a graphical representation of metadatachanges, such as the tabular displays shown in FIG. 3A and FIG. 3B maybe presented to the user. These steps may be repeated for multiple setsof associated metadata of multiple files.

Once a user initiates and confirms 814 upload of the selected files, theoriginal metadata of each selected file is replaced with thecorresponding de-identified metadata and the files are uploaded 816.

Turning to FIG. 9 , FIG. 9 is a block flow diagram of an exampleprocesses 9 for interactive display of data representing uploadedmedical imaging studies, e.g., as described herein with respect to FIGS.7A-7F. As shown in FIG. 9 , a data table comprising values of studysummary variables for uploaded medical imaging studies is accessed 902and a GUI comprising graphical representations of the data is displayed904. The displayed GUI also comprises graphical filter control elementsthat a user can use to adjust filters for controlling the data display.In particular, a user may select, via interaction with a graphicalfilter control element corresponding to a particular study summaryvariable, a sub-range of that variable to use as a filter 906. Theselected sub-range is received, and used to filter data. Updatedversions of the graphical data representations are then rendered 908 fordisplay (e.g., to update the GUI).

C. Computer System and Network Environment

As shown in FIG. 10 , an implementation of a network environment 1000for use in providing systems and methods described herein is shown anddescribed. In brief overview, referring now to FIG. 10 , a block diagramof an exemplary cloud computing environment 1000 is shown and described.The cloud computing environment 1000 may include one or more resourceproviders 1002 a, 1002 b, 1002 c (collectively, 1002). Each resourceprovider 1002 may include computing resources. In some implementations,computing resources may include any hardware and/or software used toprocess data. For example, computing resources may include hardwareand/or software capable of executing algorithms, computer programs,and/or computer applications. In some implementations, exemplarycomputing resources may include application servers and/or databaseswith storage and retrieval capabilities. Each resource provider 1002 maybe connected to any other resource provider 1002 in the cloud computingenvironment 1000. In some implementations, the resource providers 1002may be connected over a computer network 1008. Each resource provider1002 may be connected to one or more computing device 1004 a, 1004 b,1004 c (collectively, 1004), over the computer network 1008.

The cloud computing environment 1000 may include a resource manager1006. The resource manager 1006 may be connected to the resourceproviders 1002 and the computing devices 1004 over the computer network1008. In some implementations, the resource manager 1006 may facilitatethe provision of computing resources by one or more resource providers1002 to one or more computing devices 1004. The resource manager 1006may receive a request for a computing resource from a particularcomputing device 1004. The resource manager 1006 may identify one ormore resource providers 1002 capable of providing the computing resourcerequested by the computing device 1004. The resource manager 1006 mayselect a resource provider 1002 to provide the computing resource. Theresource manager 1006 may facilitate a connection between the resourceprovider 1002 and a particular computing device 1004. In someimplementations, the resource manager 1006 may establish a connectionbetween a particular resource provider 1002 and a particular computingdevice 1004. In some implementations, the resource manager 1006 mayredirect a particular computing device 1004 to a particular resourceprovider 1002 with the requested computing resource.

FIG. 11 shows an example of a computing device 1100 and a mobilecomputing device 1150 that can be used to implement the techniquesdescribed in this disclosure. The computing device 1100 is intended torepresent various forms of digital computers, such as laptops, desktops,workstations, personal digital assistants, servers, blade servers,mainframes, and other appropriate computers. The mobile computing device1150 is intended to represent various forms of mobile devices, such aspersonal digital assistants, cellular telephones, smart-phones, andother similar computing devices. The components shown here, theirconnections and relationships, and their functions, are meant to beexamples only, and are not meant to be limiting.

The computing device 1100 includes a processor 1102, a memory 1104, astorage device 1106, a high-speed interface 1108 connecting to thememory 1104 and multiple high-speed expansion ports 1110, and alow-speed interface 1112 connecting to a low-speed expansion port 1114and the storage device 1106. Each of the processor 1102, the memory1104, the storage device 1106, the high-speed interface 1108, thehigh-speed expansion ports 1110, and the low-speed interface 1112, areinterconnected using various busses, and may be mounted on a commonmotherboard or in other manners as appropriate. The processor 1102 canprocess instructions for execution within the computing device 1100,including instructions stored in the memory 1104 or on the storagedevice 1106 to display graphical information for a GUI on an externalinput/output device, such as a display 1116 coupled to the high-speedinterface 1108. In other implementations, multiple processors and/ormultiple buses may be used, as appropriate, along with multiple memoriesand types of memory. Also, multiple computing devices may be connected,with each device providing portions of the necessary operations (e.g.,as a server bank, a group of blade servers, or a multi-processorsystem). Thus, as the term is used herein, where a plurality offunctions are described as being performed by “a processor”, thisencompasses embodiments wherein the plurality of functions are performedby any number of processors (one or more) of any number of computingdevices (one or more). Furthermore, where a function is described asbeing performed by “a processor”, this encompasses embodiments whereinthe function is performed by any number of processors (one or more) ofany number of computing devices (one or more) (e.g., in a distributedcomputing system).

The memory 1104 stores information within the computing device 1100. Insome implementations, the memory 1104 is a volatile memory unit orunits. In some implementations, the memory 1104 is a non-volatile memoryunit or units. The memory 1104 may also be another form ofcomputer-readable medium, such as a magnetic or optical disk.

The storage device 1106 is capable of providing mass storage for thecomputing device 1100. In some implementations, the storage device 1106may be or contain a computer-readable medium, such as a floppy diskdevice, a hard disk device, an optical disk device, or a tape device, aflash memory or other similar solid state memory device, or an array ofdevices, including devices in a storage area network or otherconfigurations. Instructions can be stored in an information carrier.The instructions, when executed by one or more processing devices (forexample, processor 1102), perform one or more methods, such as thosedescribed above. The instructions can also be stored by one or morestorage devices such as computer- or machine-readable mediums (forexample, the memory 1104, the storage device 1106, or memory on theprocessor 1102).

The high-speed interface 1108 manages bandwidth-intensive operations forthe computing device 1100, while the low-speed interface 1112 manageslower bandwidth-intensive operations. Such allocation of functions is anexample only. In some implementations, the high-speed interface 1108 iscoupled to the memory 1104, the display 1116 (e.g., through a graphicsprocessor or accelerator), and to the high-speed expansion ports 1110,which may accept various expansion cards (not shown). In theimplementation, the low-speed interface 1112 is coupled to the storagedevice 1106 and the low-speed expansion port 1114. The low-speedexpansion port 1114, which may include various communication ports(e.g., USB, Bluetooth®, Ethernet, wireless Ethernet) may be coupled toone or more input/output devices, such as a keyboard, a pointing device,a scanner, or a networking device such as a switch or router, e.g.,through a network adapter.

The computing device 1100 may be implemented in a number of differentforms, as shown in the figure. For example, it may be implemented as astandard server 1120, or multiple times in a group of such servers. Inaddition, it may be implemented in a personal computer such as a laptopcomputer 1122. It may also be implemented as part of a rack serversystem 1124. Alternatively, components from the computing device 1100may be combined with other components in a mobile device (not shown),such as a mobile computing device 1150. Each of such devices may containone or more of the computing device 1100 and the mobile computing device1150, and an entire system may be made up of multiple computing devicescommunicating with each other.

The mobile computing device 1150 includes a processor 1152, a memory1164, an input/output device such as a display 1154, a communicationinterface 1166, and a transceiver 1168, among other components. Themobile computing device 1150 may also be provided with a storage device,such as a micro-drive or other device, to provide additional storage.Each of the processor 1152, the memory 1164, the display 1154, thecommunication interface 1166, and the transceiver 1168, areinterconnected using various buses, and several of the components may bemounted on a common motherboard or in other manners as appropriate.

The processor 1152 can execute instructions within the mobile computingdevice 1150, including instructions stored in the memory 1164. Theprocessor 1152 may be implemented as a chipset of chips that includeseparate and multiple analog and digital processors. The processor 1152may provide, for example, for coordination of the other components ofthe mobile computing device 1150, such as control of user interfaces,applications run by the mobile computing device 1150, and wirelesscommunication by the mobile computing device 1150.

The processor 1152 may communicate with a user through a controlinterface 1158 and a display interface 1156 coupled to the display 1154.The display 1154 may be, for example, a TFT (Thin-Film-Transistor LiquidCrystal Display) display or an OLED (Organic Light Emitting Diode)display, or other appropriate display technology. The display interface1156 may comprise appropriate circuitry for driving the display 1154 topresent graphical and other information to a user. The control interface1158 may receive commands from a user and convert them for submission tothe processor 1152. In addition, an external interface 1162 may providecommunication with the processor 1152, so as to enable near areacommunication of the mobile computing device 1150 with other devices.The external interface 1162 may provide, for example, for wiredcommunication in some implementations, or for wireless communication inother implementations, and multiple interfaces may also be used.

The memory 1164 stores information within the mobile computing device1150. The memory 1164 can be implemented as one or more of acomputer-readable medium or media, a volatile memory unit or units, or anon-volatile memory unit or units. An expansion memory 1174 may also beprovided and connected to the mobile computing device 1150 through anexpansion interface 1172, which may include, for example, a SIMM (SingleIn Line Memory Module) card interface. The expansion memory 1174 mayprovide extra storage space for the mobile computing device 1150, or mayalso store applications or other information for the mobile computingdevice 1150. Specifically, the expansion memory 1174 may includeinstructions to carry out or supplement the processes described above,and may include secure information also. Thus, for example, theexpansion memory 1174 may be provide as a security module for the mobilecomputing device 1150, and may be programmed with instructions thatpermit secure use of the mobile computing device 1150. In addition,secure applications may be provided via the SIMM cards, along withadditional information, such as placing identifying information on theSIMM card in a non-hackable manner.

The memory may include, for example, flash memory and/or NVRAM memory(non-volatile random access memory), as discussed below. In someimplementations, instructions are stored in an information carrier. Theinstructions, when executed by one or more processing devices (forexample, processor 1152), perform one or more methods, such as thosedescribed above. The instructions can also be stored by one or morestorage devices, such as one or more computer- or machine-readablemediums (for example, the memory 1164, the expansion memory 1174, ormemory on the processor 1152). In some implementations, the instructionscan be received in a propagated signal, for example, over thetransceiver 1168 or the external interface 1162.

The mobile computing device 1150 may communicate wirelessly through thecommunication interface 1166, which may include digital signalprocessing circuitry where necessary. The communication interface 1166may provide for communications under various modes or protocols, such asGSM voice calls (Global System for Mobile communications), SMS (ShortMessage Service), EMS (Enhanced Messaging Service), or MMS messaging(Multimedia Messaging Service), CDMA (code division multiple access),TDMA (time division multiple access), PDC (Personal Digital Cellular),WCDMA (Wideband Code Division Multiple Access), CDMA2000, or GPRS(General Packet Radio Service), among others. Such communication mayoccur, for example, through the transceiver 1168 using aradio-frequency. In addition, short-range communication may occur, suchas using a Bluetooth®, Wi-Fi™, or other such transceiver (not shown). Inaddition, a GPS (Global Positioning System) receiver module 1170 mayprovide additional navigation- and location-related wireless data to themobile computing device 1150, which may be used as appropriate byapplications running on the mobile computing device 1150.

The mobile computing device 1150 may also communicate audibly using anaudio codec 1160, which may receive spoken information from a user andconvert it to usable digital information. The audio codec 1160 maylikewise generate audible sound for a user, such as through a speaker,e.g., in a handset of the mobile computing device 1150. Such sound mayinclude sound from voice telephone calls, may include recorded sound(e.g., voice messages, music files, etc.) and may also include soundgenerated by applications operating on the mobile computing device 1150.

The mobile computing device 1150 may be implemented in a number ofdifferent forms, as shown in the figure. For example, it may beimplemented as a cellular telephone 1180. It may also be implemented aspart of a smart-phone 1182, personal digital assistant, or other similarmobile device.

Various implementations of the systems and techniques described here canbe realized in digital electronic circuitry, integrated circuitry,specially designed ASICs (application specific integrated circuits),computer hardware, firmware, software, and/or combinations thereof Thesevarious implementations can include implementation in one or morecomputer programs that are executable and/or interpretable on aprogrammable system including at least one programmable processor, whichmay be special or general purpose, coupled to receive data andinstructions from, and to transmit data and instructions to, a storagesystem, at least one input device, and at least one output device.

These computer programs (also known as programs, software, softwareapplications or code) include machine instructions for a programmableprocessor, and can be implemented in a high-level procedural and/orobject-oriented programming language, and/or in assembly/machinelanguage. As used herein, the terms machine-readable medium andcomputer-readable medium refer to any computer program product,apparatus and/or device (e.g., magnetic discs, optical disks, memory,Programmable Logic Devices (PLDs)) used to provide machine instructionsand/or data to a programmable processor, including a machine-readablemedium that receives machine instructions as a machine-readable signal.The term machine-readable signal refers to any signal used to providemachine instructions and/or data to a programmable processor.

To provide for interaction with a user, the systems and techniquesdescribed here can be implemented on a computer having a display device(e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor)for displaying information to the user and a keyboard and a pointingdevice (e.g., a mouse or a trackball) by which the user can provideinput to the computer. Other kinds of devices can be used to provide forinteraction with a user as well; for example, feedback provided to theuser can be any form of sensory feedback (e.g., visual feedback,auditory feedback, or tactile feedback); and input from the user can bereceived in any form, including acoustic, speech, or tactile input.

The systems and techniques described here can be implemented in acomputing system that includes a back end component (e.g., as a dataserver), or that includes a middleware component (e.g., an applicationserver), or that includes a front end component (e.g., a client computerhaving a graphical user interface or a Web browser through which a usercan interact with an implementation of the systems and techniquesdescribed here), or any combination of such back end, middleware, orfront end components. The components of the system can be interconnectedby any form or medium of digital data communication (e.g., acommunication network). Examples of communication networks include alocal area network (LAN), a wide area network (WAN), and the Internet.

The computing system can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.

In some implementations, modules described herein can be separated,combined or incorporated into single or combined modules. The modulesdepicted in the figures are not intended to limit the systems describedherein to the software architectures shown therein.

Elements of different implementations described herein may be combinedto form other implementations not specifically set forth above. Elementsmay be left out of the processes, computer programs, databases, etc.described herein without adversely affecting their operation. Inaddition, the logic flows depicted in the figures do not require theparticular order shown, or sequential order, to achieve desirableresults. Various separate elements may be combined into one or moreindividual elements to perform the functions described herein.

Throughout the description, where apparatus and systems are described ashaving, including, or comprising specific components, or where processesand methods are described as having, including, or comprising specificsteps, it is contemplated that, additionally, there are apparatus, andsystems of the present invention that consist essentially of, or consistof, the recited components, and that there are processes and methodsaccording to the present invention that consist essentially of, orconsist of, the recited processing steps.

It should be understood that the order of steps or order for performingcertain action is immaterial so long as the invention remains operable.Moreover, two or more steps or actions may be conducted simultaneously.

While the invention has been particularly shown and described withreference to specific preferred embodiments, it should be understood bythose skilled in the art that various changes in form and detail may bemade therein without departing from the spirit and scope of theinvention as defined by the appended claims.

What is claimed is:
 1. A method for secure upload of one or more medicalimages and associated metadata from a local computing device to anetwork-based analysis or decision support platform, the methodcomprising: (a) causing, by a processor of the local computing device,display of a graphical user interface (GUI) for user review andmanagement of medical image upload; (b) receiving, by the processor ofthe local computing device, a user selection of one or more files forupload, wherein each of the one or more files for upload comprises oneor more medical images and associated metadata comprising a plurality ofdata elements, and wherein each selected file is stored on the localcomputing device; (c) accessing, by the processor of the local computingdevice, for each selected file, the associated metadata of the file andidentifying, among the plurality of data elements of the associatedmetadata, one or more flagged data elements for de-identification priorto upload; (d) creating, by the processor of the local computing device,for each selected file, de-identified metadata corresponding to theassociated metadata of the file with values of the flagged data elementsremoved or masked; (e) receiving, by the processor of the localcomputing device, a user selection of a particular file for review ofde-identification; (f) responsive to the user selection of theparticular file, causing, by the processor of the local computingdevice, display of a graphical representation of metadata changescomprising a listing of the plurality of data elements of the associatedmetadata of the particular file and a visual indication of the one ormore flagged data elements, wherein the visual indication visuallydistinguishes the one or more flagged data elements from other dataelements; (g) receiving, by the processor of the local computing device,a user confirmation to upload; and (h) uploading, by the processor ofthe local computing device, each selected file with the originalassociated metadata replaced with the corresponding de-identifiedmetadata, to the network-based platform.
 2. The method of claim 1,comprising: (i) causing, by the processor, display of a graphicalrepresentation of the de-identified metadata that corresponds to theassociated metadata of the particular file.
 3. The method of claim 1,comprising (j) causing, by the processor, display of a graphicalrepresentation of original associated metadata of the particular file.4. The method of claim 1, wherein at least a portion of the flagged dataelements are identified as elements to be masked by, for each element tobe masked, replacing an initial value of the element to be masked with aparticular masking value, and wherein the graphical representation ofmetadata changes further comprises, for each element to be masked, anindication of the initial value of the element and an indication of theparticular masking value for the element.
 5. The method of claim 1,wherein, in the graphical representation of metadata changes, thelisting of the plurality of data elements of the associated metadata isdisplayed in a table.
 6. The method of claim 5, wherein each flaggeddata element is identified via a color coded icon.
 7. The method ofclaim 1, wherein at least a portion of the flagged data elements areidentified as elements to be masked and wherein step (c) comprises, foreach element to be masked, replacing an initial value of the element tobe masked with a particular masking value.
 8. The method of claim 1,wherein step (c) comprises accessing, by the processor, a storedde-identification protocol comprising a listing of data elements toflag.
 9. The method of claim 1, further comprising: receiving, by theprocessor, a user selection of one or more additional data elements toflag for de-identification; and updating, by the processor, thede-identified set of metadata associated with each medical image toremove or mask a value of each selected additional data element.
 10. Themethod of claim 1, wherein the one or more flagged data elementscomprise one or more members selected from the group consisting of: apatient name, a patient identifier, a patient birth date.
 11. The methodof claim 1, wherein the local computing device is in communication withan imaging system.
 12. The method of claim 1, wherein the localcomputing device is on a local network that is not part of thenetwork-based analysis or decision support platform.
 13. The method ofclaim 1 comprising: following step (b), performing, by the processor ofthe local computing device, a pre-processing step to validate each ofthe one or more selected files for upload.
 14. The method of claim 13,wherein: the pre-processing step comprises identifying, for each file, acorresponding study to which the file belongs, thereby identifying oneor more processed studies; and the method comprises causing, by theprocessor of the local computing device, display of a graphicalrepresentation of processed studies comprising a listing of the one ormore processed studies.
 15. The method of claim 14, wherein thegraphical representation of processed studies comprises, for eachprocessed study, a visual indication of a number of different files ofthe study along with a visual indication of one or more imagingmodalities used to obtain medical images of the files belonging to thestudy.
 16. The method of claim 15, comprising: receiving, by theprocessor of the local computing device, a user input to review imagesof a particular study; and causing, by the processor of the localcomputing device, display of a first medical image of a first file andcorresponding to a particular imaging modality, along with a graphicalcontrol element that allows the user to view additional images (i) offiles belong to the particular study and (ii) also corresponding to theparticular imaging modality.
 17. The method of claim 1, wherein thegraphical representation of metadata changes comprises one or more colorcoded icons in proximity to the flagged data elements.
 18. A system forsecure upload of one or more medical images and associated metadata froma local computing device to a network-based analysis or decision supportplatform, the system comprising: a processor of the local computingdevice; and a memory having instructions stored thereon, wherein theinstructions, when executed by the processor, cause the processor to:(a) cause display of a graphical user interface (GUI) for user reviewand management of medical image upload; (b) receive a user selection ofone or more files for upload, wherein each of the one or more files forupload comprises one or more medical images and associated metadatacomprising a plurality of data elements, and wherein each selected fileis stored on the local computing device; (c) access, for each selectedfile, the associated metadata of the file and identifying, among theplurality of data elements of the associated metadata, one or moreflagged data elements for de-identification prior to upload; (d) create,for each selected file, de-identified metadata corresponding to theassociated metadata of the file with values of the flagged data elementsremoved or masked; (e) receive a user selection of a particular file forreview of de-identification; (f) responsive to the user selection of theparticular file, cause display of a graphical representation of metadatachanges comprising a listing of the plurality of data elements of theassociated metadata of the particular file and a visual indication ofthe one or more flagged data elements, wherein the visual indicationvisually distinguishes the one or more flagged data elements from otherdata elements; (g) receive a user confirmation to upload; and (h) uploadeach selected file with the original associated metadata replaced withthe corresponding de-identified metadata, to the network-based platform.19. The system of claim 18, wherein the local computing device is incommunication with an imaging system.
 20. The system of claim 19,further comprising the imaging system.
 21. The system of claim 18,wherein the local computing device is on a local network that is notpart of the network-based analysis or decision support platform.
 22. Thesystem of claim 18, wherein the graphical representation of metadatachanges comprises one or more color coded icons in proximity to theflagged data elements.
 23. The system of claim 18, wherein, in thegraphical representation of metadata changes, the listing of theplurality of data elements of the associated metadata is displayed in atable in which each flagged data element is identified via a color codedicon.